Dear visitor, welcome to FertilityZone .
If this is your first visit here, please read the Help. It explains in detail how this page works.
To use all features of this page, you should consider registering.
Please use the registration form, to register here or read more information about the registration process.
If you are already registered, please login here.

Male Factor Infertility - varicocele??

Hi

I am new to these boards and have been struggling with secondary infertilty since my beautiful dd was born 4 years ago. I suffer from PCOS but investigations have shown that it hasnt affected my ovulation, when we first went to Fertility Clinic they told us that if PCOS was our only problem we shouldnt have that much to overcome with our fertility issues. When I fell pregnant naturally with my dd I was 3 stone overweight and only had a period once every 3 or so months, but since her birth a lot of my PCOS symptoms were regulated and I now have more or less a normal menstrual cycle, so you can imagine our shock and heartbreak when we found out that my dh has very low motility and morphology issues. Less than 4% normal forms with only about 14% rapid progressive swimmers. He has had 3 semen analysis and each one has been progressively worse, with the latest now showing a reduction in his count. He has a very large grade 3 varicocele on the left side and we paid privately to see a Urologist who told us that the chances of a varicolectomy improving things is very slim. Otherwise he is a fit and healthy man. It breaks my heart that we wont be able to have anymore children - we have been ruled out for IUI because the specimen is so bad and I cant quite get my head round IVF at this stage. I am 29 and my dh is 31, Im really looking for some encouragement or advice from others who have similar experience or whose dp has been through this surgery - I want to know should I be fighting for the varicoclectomy because of the grade or is this futile?? I appreciate any advice and am glad that i've found this board with people in a similar position but at the same time my heart breaks that so many of us are in the same lonely, frustrating, angry, heartbreaking boat.

The presence of enlarged and varicosed veins on the scrotum known as varicoceles is moderately common, and there is still a great deal of debate as to how much impact these have on sperm production, and how this happens. There are two theories about this. One is that the excessive blood supply through the swollen blood vessels to the area causes overheating of the testicle (or testicles, as they are often bilateral), and this overheating can reduce sperm production. The other explanation is that there is pooling of blood in these distorted veins which produces toxins that inhibit sperm production. The former explanation is most likely, and especially when it is a large varicocele.

How much impact they make depends upon how large they are, and if DH's is large then it is likely that one or other of the above factors could be actively reducing sperm production. If it is large enough for him to have felt regularly uncomfortable in his groin then it is large enough perhaps to have surgery on for this reason alone. Surgery these days is usually just a case of injecting a chemical which sets in the vein and blocks it, and this should not be a major trauma for him. The full benefits (if any) will not then be seen for 3-4 months, as with all treatments for sperm problems.

Alternatively if it really is not so large as to be a fertility problem as the urologist suggests, and not troubling him, DH should perhaps put his surgery on hold, and try to compensate for the overheating by doing other things to reduce the scrotal temperature, wearing shorts, avoiding long periods of exercise or sport (especially cycling, reducing the temperature of his bath or shower, splashing his bits with cold water, especially during the hot summer days, reducing weight, which keeps the testicles too confined to the body, light clothing and of course the boxer shorts. These combined can probably do as much as surgery will for small varicoceles.

Varicoceles (and probably other causes of overheating) rarely have a very large impact on the sperm output, unless they are large bilateral ones and surgery is done then as much for his comfort as for his fertility. They rarely make a man with a totally normal picture into a totally infertile man, but they can be a factor in reducing sperm production, and they can, for a man already having a problematic sperm picture, add in to this to reduce sperm count and quality even further. The fact that you conceived for years ago when you had irregular ovulation and extra weight, and yet cannot do so now when you would seem to be more fertile, suggests that something important may have changed. This may be in you, that despite your regular cycles these are not very good ovulatory ones, ie your mid-luteal progesterone is lower than ideal for good implantation, and this needs to be checked. Or it could mean that his sperm four years ago were not just adequate but better enough than average in terms of number and quality, to get you pregnant despite your own obvious fertility problems, but that now the sperm picture has deteriorated to the point where you are needing major help to conceive. Unless you can identify any other factors which might have caused this deterioration, then it is reasonable to suspect that this is perhaps due to the increasing presence of his variocele.

I obviously cannot comment too greatly on the accuracy of the urologist's opinion, especially so as I am not a urologist nor a surgeon. It is true that not always does varicocele treatment improve fertility even when one expects it to, but there is certainly evidence to suggest that there is no exact and consistant correlation between varicocele size and sperm improvement and surprising results can be obtained at times. The urologist may very well be correct in his assessment, or he may have been looking at your husband solely as a man with a current problem and not taking into account your very significant pregnancy history. It might be useful to speak again to this consultant and see whether he would revise his opinion, and if not seek another opinion, perhaps from a more fertility aware urologist recommended by a fertility unit or gynaecologist or your GP.

I would suggest that you follow this up this for the various reasons I have given above.

I have only had day 3 bloods done as the fs decided it was not worth doing a lap and dye based on dh's results. I have been pushing for further investigations though and atm am waiting on day 23 bloods to be done - I have also been advised to do opks to detect if im ovulating (and I have used these in the past and always get an lh surge more or less when im meant to) Doc said based on these results it would be pretty safe to say that im o'ing - he said if theres any question mark over that then we could look at clomid while on the waiting list for ICSI.

From all I have read regarding varicocele, my dh's sa result is typical of a man with a very large varicocele - ie. gets progressively worse with time.

I am hoping that I dont also have issues as that would make the mountain twice as high to climb.

At the minute my dh has started taking Wellman Conception Vits, saw palmetto for prostate health (his samples did not liquefy within 20 mins and while the fs didnt seem to think this was much of a concern, personally I do! lol) He is also taking Horse Chestnut extract after I read that it is beneficial for men with varicocele and general veinous health.

FS has said he will write to Urologist to say we are very keen to have the surgery, dh just wants rid now because regardless of the questionable evidence that it will improve motility/morphology issues we want to know we are doing everything that we possibly can to help things.

Hi, my DH has a smaller varicocele and we spoke to our consultant about an op but he gave us the same response as you - that surgery wouldn't necessarily help things at all and it would put DH out of action for a while. I also have fertility issues so we decided without a doubt that IVF/ICSI was right for us, obviously that is a big step and you have to decide what you want to do. I do know that DH's count was variable and this depended upon how well he had been and also we believe that selenium and zinc tablets (from Holland and Barrett) may have given him a boost. It's worth a go. All the best x

A bit late seeing this thread but thought i would answer anyway. A friend was told the same re her hubbies variocele and was due to start IVF. However the variocele was causing her hubbie pain so they operated on it before the IVF started...a few months later she was pregnant naturally with twins and 18mths after that pregnant again..